Example on How a High Deductible Plan Works

You Pay Everything

When your plan starts, you pay all of your medical costs until you reach a fixed amount, called a deductible.

We Pay 75%

Once you reach that fixed amount, you will only pay a percentage of the cost of your medical bill when you get care.

You Pay 25%

We Pay Everything

Any deductible, copay, coinsurance or out-of-pocket expense for covered services goes toward an out of pocket maximum. If you reach this amount, all you need to do is pay your monthly premium. Then, we'll pick up the tab for all of your covered services.

High Deductible Health Plans

What is a HDHP?

A high deductible health plan, also known as a HDHP, has a lower monthly premium, but you’ll pay for most of your care until you meet your deductible. When a HDHP is paired with a Health Savings Account, you can set aside tax-free money for current health care expenses and build savings for the future. Learn more about how to manage your costs with a HDHP plan.

There are a few things you need to know:

Deductible: This is the amount you pay first before sharing your costs with us.

Copay: A fixed amount, like $25 you pay when you receive care or pick up a prescription.

Coinsurance: This is similar to a copay but instead of a fixed dollar amount, it is a percentage of the total bill. For example, if your child’s eyeglasses are $100 and you’ve met your deductible, your coinsurance payments of 50% would be $50. We would pay the rest, or $50.

Out-of-pocket maximum: This is the most you could ever pay in a year on covered health care services, excluding your monthly premium. Any deductible, copay, coinsurance or out-of-pocket cost for covered services goes towards your out-of-pocket maximum. If you reach this amount, all you need to do is to continue paying your monthly premium. We’ll pay 100% of the cost when you get care for covered services.

Each person only has to pay his or her own deductible on the plan. For example, Dan, Melanie and Ruby have a deductible of $1,200 for the family. Say Dan meets his $400 deductible. He would start paying copays (a fixed amount, like $25) or a coinsurance (a percentage of the total bill) for his care. Then, any combination of the remaining family members can meet the remaining $800 deductible. Once they reach that amount, everyone will only pay a copay or coinsurance for their care.

If you have the Bronze Select or Silver Select plans, here’s how your deductible adds up:

All family members in any combination will pay toward meeting the family deductible. For example, Eric and Jess have a family deductible of $5,000. They are going to pay the full cost of their care until together they reach $5,000. Once they reach that amount, they both will pay only a copay (a fixed amount, like $25) or a coinsurance (a percentage of the total bill) for their care. If it’s just one person on the plan, then you will only pay one deductible.

All plans cover the prescriptions that you rely on.

The difference is in how much you have to pay for your prescriptions. With some plans, you pay the full cost until you reach your deductible. With other plans, you pay a copay for your prescription. If your plan includes a deductible and you use diabetic drugs and supplies, you will have to pay the full cost until you meet your deductible. If you’re not sure how much it might cost, call the number listed on the back of your member card.

Managing Your HDHP

It’s also important to know what is covered and what something might cost you. Preventive care for the most part is covered in full. But costs vary based on the provider you see, the facility you visit and the procedure you may need. And there are a few ways to find out how much something might cost:

Call your doctor or specialist ahead of time and ask how much the anticipated service will cost.

Log into your member account to check your benefits or call our Customer Care Advocates at the number listed on the back of your member card.

Use our cost estimator (login required). This tool provides an estimate of what a procedure might cost among different doctors in the area.

Tax-free funding account

Tax-free funding account

You also have the option to set up a unique account called a Health Savings Acccount or HSA to help you cover qualified medical expenses. It’s a tax-free account that you you can roll over each year. Talk to a financial planner about setting up an HSA.

Funding Account Options for your HDHP

Talk to your employer or benefits administrator about what funding options might be available for you for your HDHP.

A Health Savings Account (HSA) is a tax-free account that you own and you can use to pay out-of-pocket medical expenses. The money in an HSA can roll over each year.(If you have dependent(s) on your plan, the Internal Revenue Service has rules about how you use your HSA funds for them)

A Health Reimbursement Account (HRA) is a tax-free account that your employer funds that you can use for qualified medical expenses each year.